Pyloromyotomy: Technique and use for gastric drainage combined with vagotomy

Abstract

Gastric drainage must accompany vagotomy and for this purpose gastro‐enterostomy and pyloroplasty are equally effective. When the stomach requires to be extensively mobilized, as for high oesophagogastric anastomoses, these drainage operations interfere with important collateral vessels and they may impede mobilization of the stomach by shortening or anchoring the gastric outlet. In this situation both internal pyloric stretching and stretch pyloromyotomy have, over a period of 10 years, provided effective gastric drainage. Internal pyloric stretching without myotomy would seem to be the ideal decompressive manoeuvre for cases of high gastrooesophagectomy. Pyloric stretching with or without myotomy has been used in 56 cases of transthoracic hiatus hernia repair accompanied by vagotomy for associated duodenal ulcers. The technique was used originally only because it was simpler than a pyloroplasty to perform through a left thoracotomy. On the basis of postoperative symptoms, gastric emptying times, and fasting gastric secretion volumes, it has proved as effective as other drainage procedures provided duodenal or pyloric fibrosis is absent or minimal. The technique permits of accurate hernia repair with vagotomy through a standard left thoracotomy.

Usefulness of Pyloromyotomy With Transhiatal Esophagectomy in Improving Gastric Emptying

“…This appeared in both liquid and solid phases. These results coincide with previous literatures utilized pyloroplasty as a gastric drainage procedure [6, 8]. …”

“…The results of Marchand [6] recommended using the easier pyloric stretching method rather than pyloroplasty which interferes with the important collateral vessels in the pyloric region, and they may impede mobilization of the stomach by shortening or anchoring the gastric outlet. Like pyloroplasty, pyloromyotomy might also have the same effects on the pyloric collateral vessels which might delay the gradual readjustment and return of the terminal antrum or pylorus to normal.…”

“…Only a minority of patients develops GOO after esophagectomy, and they may predispose to dumping and duodenal bile reflux, and thus impairing late postoperative functional outcome [5]. They may interfere with mobilization of the stomach by shortening or anchoring the gastric outlet [6]. Moreover, it has been reported that gastric drainage following esophagectomy has no influence on the delayed gastric emptying (GE) [7], and the foregut function improves with time, regardless of a pyloric drainage procedure [8, 9].…”

Comparison of pyloromyotomy, pyloric buginage, and intact pylorus on gastric drainage in gastric pull-up surgery after esophagectomy

“…[415] Moreover, the methods could impair gastric mobilization due to shortening or anchoring the gastric outlet. [16] Hence, some do not advocate using of the methods during esophagectomy. [15]…”